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INTEGRATED CARE PARTNERSHIPS


tHE MID AnD EASt AntRIM AgEWEll PARtnERSHIP MAY HAVE RECEIVED £1M fUnDIng foR tHEIR fAntAStIC olDER PEoPlE InItIAtIVE, BUt AS tHE RECEnt IntEgRAtED CARE PARtnERSHIP IMPACt REPoRt SHoWED, olDER PEoPlE tHRoUgHoUt tHE noRtH ARE BEnEfIttIng fRoM tHE WoRK of tHE ICPS…


ICPS PRoVIng to BE lIfElInE foR olDER PEoPlE o


lder people across northern Ireland are feeling the effects of the great work being done


by Integrated Care Partnerships (ICPs) across the province.


In Belfast, the ‘Acute Care at Home’ service provides people aged over 75 with expert medical and social care in their own home, to avoid admission to hospital. An integrated team of healthcare professionals work together to help older people manage conditions such as chest infections, urinary tract infections, cellulitis and dehydration. Patients have, within their own home environment, the same access to specialist tests as hospital inpatients, and receive a consultant-led assessment and treatment. the average length of stay in the service at home is six days, compared to an average eleven-day stay in hospital for older people in Belfast.


In 2015/16 274 older people were provided with care in their place of residence and therefore avoided a hospital admission, saving 3014 bed days.


In the Western trust area, meanwhile, a Social Prescribing programme was piloted to help older people address social, emotional or practical needs by linking them to sources of support and activities within their local community. the pilot involved Aberfoyle Medical Practice and Eglinton Medical Practice and was delivered by Bogside & Brandywell Health forum, in conjunction with Rural Area Partnership in Derry (RAPID).


58 - PHARMACY In foCUS


older people referred to the service by their gP were visited by a Social Prescribing Coordinator to discuss suitable options including social clubs, physical activity, self-help groups, volunteering, learning, counselling, and advice and guidance services.


the majority of people referred had a long-term condition, emotional problems or suffered from loneliness. Most referrals were made to exercise opportunities or older people’s social clubs.


from April 2015 to May 2016 107 people were referred to the programme, with 82 people going on to participate in social activities delivered by the community and voluntary sector. feedback from patients clearly evidenced fewer visits to their gP.


In the Southern trust, ICPs have enabled the extension of the Southern HSC trust Acute Care at Home service to provide support until 10pm on weekdays and from 8am to10pm on weekends. In total, the extended service has received over 1084 referrals, half of which are from nursing homes.


ICPs also introduced a dedicated Acute Care at Home pharmacist in the Southern area to enable swifter dispensing of medication to patients using the service and to review medications being taken by patients. Between September 2014 and April 2016 175 patients have had their medications reviewed to ensure best practice is being followed.


In the northern trust area, the ‘nursing Home In-reach’ initiative focuses on very frail older people living in nursing homes, who commonly experience a high level of attendance at hospital Emergency Departments. the aim was to develop and deliver a specialist education, training and development programme for staff working in nursing homes in the Antrim/ Ballymena area to enable them to provide more care for their residents in the home, rather than in hospital.


two members of staff from each of the 20 participating nursing homes took part in training including: long term conditions management; dementia care; recognising /managing the deteriorating patient; medicines optimisation; end of life care; catheter management; Peg tube management; syringe driver management and venepuncture.


these staff then cascaded this learning to their colleagues within the home. A Practice Development facilitator provided a ‘case finder’ function to track patients who attend ED to determine the appropriateness of that attendance, and then to provide follow up support to the home, such as additional staff training, to avoid a reoccurrence.


the increased knowledge and skills of nursing home staff in the pilot has resulted in a 25 per cent reduction in the number of visits from Marie Curie staff out of hours; a 21 per cent reduction in the number of calls made to district nursing services compared


to the same period in the previous year and a 48 per cent reduction in the number of calls to the hospital diversion nursing team relating to PEg tube issues.


finally, in the South-Eastern area, the ICP established a new Coordinated falls Service for people who have fallen at home, and have been attended to by the nI Ambulance Service (nIAS).


In 2012/13, nIAS responded to 4239 falls in the South Eastern area. now, unless the person requires hospital admission for an injury, nIAS staff can now refer the person directly to the falls Prevention Service and enable them to receive treatment at home.


Between June 2015 and May 2016, nIAS referred 167 patients to the service. ICPs have secured funding for an additional four falls Assessors, who can also refer the person onwards to other sources of support, such as occupational therapy, physiotherapy and podiatry, nursing services, gP or community and voluntary sector services.


from April 2015 to May 2016, 1373 falls assessments were carried out in patients’ homes. Patients who have been prescribed four or more medicines are at risk of falling, and a dedicated pharmacist has been put in place to review those patients’ medicines. As a result of their efforts, 1088 bed days have been avoided from January to April 2016. •


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